HOLLARD MAKES MISREPRESENTATIONS TO THE OMBUDMAN'S OFFICE

I took out two credit life insurance policies with Hollard during 2017/2018. In July 2018 I suffered a permanent disability following an accident. I duly lodged claims with this company's administrators, IUA, as provided for in the policy. They initially accepted temporary disability and paid a number of instalments on the credit agreement. Then they cancelled the policies based on the credit provider's instructions. However, the T's and C's of the policies did not empower them to accept such instructions from the credit provider. They wholly failed to advise me about the cancellations as required in terms of statute and in terms of the policy.

It was only during October 2020, when I ultimately received an outcome to my permanent disability claims, that I also learnt about the cancellations. The cancellations were very clearly ******** in as much as they were contrary to the provisions of the policies.

IUA, on behalf of Hollard, informed me that my claims for permanent disability benefits were repudiated (on 14/10/2020) as my medical reports do not show permanency of my impairment/disability. I provided them and Hollard with Specialist Medical Reports showing the permanence of my condition EXPRESSLY and the effect of my condition on my ability to perform my profession. The medical reports are VERY CLEAR and SPECIFIC and they are not in dispute.

However, after requesting a review of the cancellations and of the repudiation of my claims from Hollard, I waited for SIX MORE MONTHS, from October 2020 until April 2021, for Hollard to provide me with an outcome to my requests for review of their internal decision. No outcome to my review requests were forthcoming, and I referred a dispute to the Ombudsman for Long Term Insurance, which dispute is currently still being processed before that office.

Of substantial concern to me is the material misrepresentations made on behalf of this insurer to the Ombudsman's office. The latest attempt they are making to avoid paying in terms of their promise, is to unilaterally allege that I lodged a "LOSS OF INCOME" claim, whereas, for the past three years it was clear from all correspondence (their own included) that the type of claim is a Permanent Disability Claim. THERE IS NO CORRESPONDENCE OR CLAIM FORMS FOR A CLAIM FOR LOSS OF INCOME. However, this insurer is just evolving additional reasons unilaterally to avoid acceptance of their liability. They are in fact making an intentional, ******** misrepresentation to the Ombudsman's Office, which prima-facie constitutes the common-law crime of *****.

I say their conduct is ********, because this policy is subject to the provisions of the Long Term Insurance Act, 1998, which in Section 62 thereof provides for POLICYHOLDER PROTECTION RULES (known as "PPR's). These are subordinate legislation that provides protection to consumers in the Long Term Insurance sector.

In terms of the 2004 and 2018 PPR's, an insurer must inform a claimant for policy benefits of (all) the reasons for REPUDIATING a claim and the said notice containing such reasons is therefore a "STATUTORY NOTICE" in as much as it has its origin in the statute (PPR's). In terms of Section 62 of the LTIA it is a ******** OFFENCE for an insurer to infringe upon an insured person's rights contained in the PPR's.

I have highlighted the above to the office of the Ombudsman, but no ruling ahs to date been issued by the Ombudsman.

I therefore write this review in order to show consumers how this insurer operates, not complying with the legislation and the rules and even going as far as making misrepresentations to the watchdog's office, merely in order to avoid payment.

It is said that an insurance policy is one of "good faith", but this insurer clearly lacks this quality, unfortunately.